Social Anxiety Disorder (SAD)

Social anxiety is something that everyone experiences at some point. We feel tense and nervous around other people, especially those we are trying to impress. We feel pressure to be interesting and likable. We get tongue tied, and endure awkward silences. All of this is normal and universal. Many people are labeled as being “shy”. Social Anxiety Disorder (or Social Phobia) is not the same. Individuals withSocial Anxiety Disorder suffer from a severe, persistent terror of other people that that controls their lives.

What It’s Like to Have Social Anxiety Disorder

Sufferers fear humiliation, rejection, negative judgment, or not making a good impression. The fear is so intense that they are unable to make human connections, and if not treated may end up going through life isolated. This leads to depression, low self esteem, feelings of helplessness, and bitterness toward the self or society at large. Drug and alcohol abuse often occurs. Individuals with this disorder tend to overdo their drinking at social gatherings in an attempt to relax and connect with others.

One of the most difficult aspects of SAD is that social situations create anxiety, and this leads to anxiety about others seeing the anxiety. SAD sufferers are excessively worried about others seeing them shake, tremble, sweat, stutter, or blush. Many have Panic Attacks as a result of their anxiety. They may avoid social activities all together, or endure them with intolerable angst. People with Social Anxiety Disorder are painfully aware that their anxiety is excessive or illogical. But as in other anxiety disorders, they cannot help it.

Social Anxiety Disorder can occur in all social situations, and can be a universal fear of interacting with others, or it can be limited to a few social domains. For example, it is possible for an individual with SAD to be perfectly fine around family and close friends, but become socially anxious at work functions, parties, or meetings.

According the Anxiety Disorders Association of America and estimated 15 million Americans have Social Phobia. Symptoms of SAD begin to show at around age 13, and 36% of individuals who suffer from this disorder report that they have had their symptoms for 10 or more years before seeking help from a professional.

Causes of this disorder vary and are not universal. The following are possible contributing factors to the development of Social Anxiety Disorder:

  • Genetics have a role to play in that if either of your parents have SAD then you are 2-3 times more likely to have it as well.
  • Growing up in an overprotective and isolated family, and not having much exposure to social activities as a child may create a higher risk of developing the disorder.
  • Only children may be more at risk, especially if coddled at home and isolated from other children. They have great difficulty adjusting to a world they perceive by comparison to be cold and rejecting. They may become afraid of children their own age and cling to adults.
  • SAD is affected by unrealistically high performance standards typically imposed in childhood, and these high standards are carried into social situations. People with high performance standards are critical of themselves (and often of others as well), scrutinize their every action and believe that others are doing the same to them.
  • Trauma can be at the root of Social Anxiety Disorder. Childhood bullying, and teasing might trigger or worsen social anxiety.
  • Social Anxiety Disorder may have its roots in early childhood based on rejecting interactions with maternal/paternal figures.
  • Social Phobia may be acquired through learning from primary caregivers who have a fear of interactions, isolate, and have negative ideas about people and society.

The severe self consciousness that accompanies this disorder will serve to maintain it. All of the SAD sufferers attention and energy is directed at the self: What am I doing? What do I look like? What am I going to say? For this reason, they are not able to focus and engage with the interaction that they are having. Connection does not form, and this leads the individual to feel rejected once again. See this article on this site for more on this issue: The Importance of Empathy in Drecreasing Social Anxiety.

Treatment of Social Anxiety Disorder involves both psychotherapy and medication. Psychotherapy is essential and medications may or may not be used, but a combination is typically most recommended. Psychotherapy treatment can include the following modalities:

  • Cognitive Behavioral approaches that challenge over emphasis on negative interactions and faulty thinking that maintains anxiety.
  • EMDR for resolution of any underlying interpersonal trauma.
  • Psychodynamic treatment to address early childhood interaction with parents, and any real or perceived rejection by primary caregivers.
  • A warm, accepting, and empathic therapeutic alliance that allows the individual to interact successfully with the therapist.
  • Group therapy is essential at a later stage of treatment is to help the individual overcome fear of interacting with others.

If a lot of what is in this article resonates with you, and you feel ready to face you social anxiety, please reach out for help. Here are a few more resources that provide information about this disorder and a link to a group run by my associate Jennifer Cornett.

Social Anxiety Support Group

A forum for people with Social Phobia

Anxiety Disorders Association of America

A Documentary on Social Anxiety